Abstract 896: Clinical Implications of JUPITER in a United States Population: Insights From the Atherosclerosis Risk in Communities (ARIC) Study
BACKGROUND: The JUPITER trial showed benefit of statin use in primary prevention of cardiovascular disease (CVD) in individuals with high-sensitivity C-reactive protein (hs-CRP) ≥2.0 mg/L and low-density lipoprotein cholesterol (LDL-C) <130 mg/dL. To assess the potential impact of JUPITER in a general population, we studied the proportion of individuals meeting eligibility criteria of the JUPITER study and their clinical outcomes in the Atherosclerosis Risk in Communities (ARIC) study.
METHODS: Participants were stratified into 4 groups based on LDL-C and hs-CRP levels, with cutoffs at 130 mg/dL and 2.0 mg/L, respectively. Incident CVD events in each group were examined (mean follow-up 6.9 years) and compared.
RESULTS: Of 8,907 age-eligible participants, 18.2% (n=1,621) were “JUPITER-eligible” (hs-CRP ≥2.0 mg/L, LDL-C <130 mg/dL). Individuals with hs-CRP ≥2.0 mg/L were more likely to be women, black, have higher triglycerides, blood pressure, body mass index, and lower high-density lipoprotein cholesterol, and have higher rates of CVD and mortality in follow-up regardless of LDL-C (p<0.0001)(Table⇓). In the JUPITER-eligible group, the rates per 1,000 person-years of CVD (15.73) and mortality (14.82) were similar to the JUPITER placebo group. If JUPITER hazard ratios were applied to this group, the number needed to treat to prevent one CVD event would be estimated at 38 over 5 years and 26 over 6.9 years.
CONCLUSION: This large U.S. population-based study supports the association of hs-CRP with elevated CVD risk and mortality regardless of LDL-C suggesting a substantial portion of the population would be eligible for therapy if the JUPITER criteria were applied. JUPITER Exclusions: Prior history of ischemic CVA/CHD (n=1041 and 172 missing data), diabetes (n=1480 and 1 missing data), lipid lowering therapy (n=678 and 13 missing data), creatinine > 2.0 mg/dL (n=9), triglycerides ≥500 mg/dL (n=0) The participant characteristics are adjusted means or percentages except for age, sex, and race, which are unadjusted, and for hsCRP, which are unadjusted medians. The participant event rates are adjusted for age, gender, and race. ‡CV events include stroke, MI, unstable angina, revascularization (CABG/PTCA), & fatal CHD.